Darn that breech baby!

I just returned from helping a wonderful couple welcome their little girl into the world! This baby had remained stubbornly frank breech since about 35 weeks, despite every attempt to turn her. Mom even tried an external version, along with all the acupuncture, chiropractic treatments, positioning, hot/cold, talking, bright lights, music, slant board, and visualization anyone could dish out!
And the little girl did not want to turn. The originally planned homebirth became a cesarean in the hospital. So different then the parents imagined. Mom had such grace and confidence as she slowly came to terms with the surgical birth. They wrote a birth plan to honor the things that were still important to them. Selected a facility and surgical team who were respectful and sensitive. Played their own music in the OR, walked into the operating suite, delayed newborn weighing, got skin to skin while on the surgery table, took lots of pictures, and remained skin to skin for hours after surgery back in the room. The little girl was healthy and happy and snuggled up at her mama’s breast when I left.

Yet, I can’t help but wonder? Isn’t breech just another variation of normal? Why are providers not being taught the skills to assist at a breech birth? (“Hands off the breech” being the first one!) Every breech birth puts the mom on the path to navigating the VBAC journey in the future, and choices around VBACs are getting slimmer and slimmer, at least in my community.

Why is breech birth considered safe and the standard of care in many communities and in others, it means automatic surgery? How can that be evidence based medicine?